About sunoor

Dr. Sunoor Verma is a strategy expert who has worked in low-, middle- and high-income countries with UNICEF, UNHCR, UNDP, and WHO. He has also been associated with Cambridge University, Boston University, and Geneva University. Dr Sunoor is a strategic communications and partnership expert who has built effective coalitions to advance complex development agendas. He is a sought-after speaker and moderator at high-voltage panels. In addition, he coaches, and mentors elected officials, parliamentarians and senior government officials in strategic communications and media engagement.

For healthy & happy kids, reduce screentime now!

Posted on March 18, 2023 by sunoor

Sunoor is seen here narrating Dr Bindeshwar Pathak’s inspiring story to Sulabh International School students in Palam. Sunoor is the founder and series editor of the Namaste Series! a project that captures the inspiring journey of s/heroes from the global south and turns them into story books.

Published by Radio Nepal on 18 March 2023

Unreasonable screentime threatens children’s mental and physical well-being and is a significant parenting challenge today! According to the World Health Organization (WHO), 10% of youngsters over the globe suffer from mental problems. This is especially troubling, considering that childhood and adolescence are crucial periods for mental health. The brain undergoes significant growth and development during this period. Children and adolescents develop cognitive and social-emotional skills that influence their future mental health and are crucial for adopting adult roles in society.

Early adverse experiences in homes, schools, or digital places, such as exposure to violence, the mental illness of a parent or other caregiver, bullying, and poverty, raise the likelihood of developing mental illness. In addition, too much time spent in front of a screen has been related to sleep deprivation, speech delays, poor social skills, and other life issues. When screentime becomes an all-consuming pastime for youngsters, this is dubbed screen addiction.

What is unreasonable screentime and screen addiction?

Screen addiction describes the compulsive and excessive use of electronic devices such as smartphones, tablets, and laptops. While technology has undoubtedly made our lives easier, it has also had several detrimental implications, notably regarding mental health. Children are vulnerable to screen addiction, which can harm their mental health.

Addiction symptoms include the inability to stop taking the substance or when the substance’s use begins to interfere with one’s life or relationships. The symptoms are identical when it comes to youngsters and screens.

How does screen addiction impact health?

The increased risk of developing anxiety and despair is one of the most significant ways that screen addiction impacts children’s mental health. Excessive screen usage is related to elevated levels of stress, anxiety, and depression in youngsters, according to research. This is due to several factors, including the social isolation that frequently results from excessive use of electronic devices, the overstimulation of the brain that occurs when children are exposed to an excessive amount of visual and auditory stimuli, and the disruption of sleep patterns that can arise when screens are used too close to bedtime.

Your child’s danger of being exposed to cyberbullying and pornographic material increases as they spend more time on phones and other screens. Similarly, more time spent on social media is frequently associated with sadness and internalizing issues. In addition, spending more time in front of a screen is associated with a decrease in parental bonding, according to scientific research.

The negative impact of unreasonable screentime on Physical Health

In addition to harming children’s mental health, screen addiction can negatively impact their physical health. For instance, children who spend an excessive amount of time seated in front of screens are at risk for acquiring obesity, which is related to a variety of physical and mental health issues. In addition, excessive screen time can result in eye strain, headaches, and other physical pain, exacerbating stress and anxiety.

Reducing screen time for children can be challenging, mainly when screens are often used for entertainment and educational purposes. However, here are some practical tips for reducing screentime for children.

What can parents do to manage screen time for children?

Parents and caregivers must actively supervise their children’s screen time to reduce their excessive use of electronic devices. Establishing explicit guidelines and limits for screen use is one approach to this. For instance, parents may limit screen usage to a set number of hours per day or require screens to be turned off at least one hour before bedtime.

Key Tips

Use parental controls on the devices: Parental controls can effectively limit screentime and restrict access to certain apps or websites. Parents can use parental control features on devices or install third-party apps to help monitor and control their children’s screentime.
Encourage youngsters to participate in activities that support their physical and mental health as another method for reducing screen addiction. This could be outdoor play, reading, artistic pursuits, or time spent with friends and family. In addition, parents may limit the amount of time their children spend in front of screens and create healthy behaviours by encouraging their children to participate in these activities.
Establish tech-free zones at home: Establishing tech-free zones in the home, such as the dining table or the bedroom, can aid in reducing the amount of time youngsters spend in front of devices. In addition, to foster more face-to-face engagement and family time, parents can advise youngsters to leave their devices in another room during these times.
Finally, parents may exhibit responsible screen use. Children typically emulate their parents’ behaviour; therefore, if parents are constantly checking their phones or watching television, it is conceivable that their children will do the same. By demonstrating appropriate screen usage, parents can provide a positive example for their children and encourage the development of mental and physical health-promoting activities.

screentime, screen addiction, parenting, family time

Encourage youngsters to participate in activities that support their physical and mental health as another method for reducing screen addiction. This could be outdoor play, reading, artistic pursuits, or time spent with friends and family.

Action points for advocacy organisations

Organisations advocating for children’s mental health need to develop new strategies to integrate screentime advocacy into their mandate. Similarly, strategic partnerships in the public and private sectors must be established to address the growing challenge of screen addition.

Published by Radio Nepal on 18 March 2023

About the Author

Dr Sunoor Verma is a global health practitioner. He has advised WHO, UNICEF, UNHCR, HUG-Geneva and Cambridge University on Strategy, Leadership Communication, Advocacy and Resource Mobilization. He has set up and led the country and regional operations for the European Centre for Minority Issues in the Balkans. He has supported track two peace processes in Macedonia, Kosovo and Sri Lanka and emergency response to the Tsunami, Avian Influenza and COVID-19. He has taught Global Health at Boston University. He has curated partnership initiatives with Macedonia, Kosovo, Germany, Switzerland, Australia, and Nepal parliamentarians. He divides his time between the foothills of the Jura Mountains in France and Buddhanilkantha in Nepal.

Additional Resources

Here is a fantastic article with a step-by-step “How to.. ” Guide to screen addictions and responsible digital use by Holly Nibllet. In this article, the author discusses the advents in technology and how to control mobile screen time. How COVID-19 has changed our viewing habits, along with screentime data for children from the UK, is presented.
Published in 2019 is another practical guideline Digital Guidelines: Promoting Healthy Technology Use for Children by the American Psychological Association.
The American Academy of Pediatrics has established recommendations for children’s media use. Their current recommendations advise:
- For children under 18 months, avoid screen-based media except video chatting.
- For children 18 months to 24 months, parents should choose high-quality programming and watch with their children.
- For children 2 to 5, limit screentime to one hour per day of high-quality programming.
- For children 6 and up, establish consistent limits on the time spent using media and the types of media.
A documentary worth watching is by Carlota Nelson, director of the documentary Brain Matters, which explores why too much screentime can harm babies and the importance of ensuring children enjoy off-screen experiences. Also, check out her engaging interview on the thinking behind this film.

Health communication fatigue looms large

Posted on March 16, 2023 by sunoor

Over-communicating health- can it ever be counterproductive?

We seem to be over-communicating health in the aftermath of COVID-19 and now run the risk of making our communication ineffective the next time a health emergency arises. The miracle of antibiotics, when prescribed appropriately, is best known to the patient whose condition starts improving quickly. However, this does not mean antibiotics are the solution to every illness. If given indiscriminately, the damage can be vast and irreversible. Similar is the case with health communication.

The risk of communication fatigue

While the pandemic showed the necessity of public health communication, it may now be causing communication fatigue among the public. It is essential to review the frequency and volume of health communication. COVID-19 taught governments, health organisations, and public health professionals how to communicate complicated scientific knowledge to the public in an understandable and actionable manner.

In the public interest, centre stage was provided to the World Health Organisation (WHO) to be the lead UN spokesperson on COVID-19. The UN Secretary-General showed admirable discipline in ensuring that Dr Tedros, the Director General of the WHO, leads the UN in critical communication during the pandemic. Health has been at the heart of every important policy debate over the last two years. The audience’s attention gained on the importance of human and animal health can be easily lost if strategic choices are now not made on how much to communicate and what to communicate on health.

In 2020, WHO coined the word Infodemic to describe an outbreak of information, disinformation, rumours, and fake news. Now it seems critical that international health actors do not turn into perpetrators of Infodemics, especially in the context of countries.

Endless marking of health days- risk of losing public trust and credibility

In February, health agencies marked World Cancer Day, International Day of Zero Tolerance for Female Genital Mutilation, International Day of Women and Girls in Science, International Epilepsy Day, and Congenital Heart Defect Awareness Day. Similarly, in March, the impressive line-up is International Women’s Day, World Kidney Day, World Oral Health Day, and World Tuberculosis (TB) Day. And in April, we will mark World Health Day, World Malaria Day, World Immunization Week and World Day for Safety and Health at Work.

The point is that for each of these special days, we see events being organised with elaborate ceremonies, the printing of banners, posters, selfie stands, speeches, t-shirts, standees and most troubling- an avalanche of social media posts with reminders on the importance of whatever is being celebrated. This country level health-Infodemic which I call “HelDemic”, is not limited to the digital space but is also sucking up the valuable time of policymakers and health workers and generating tons of plastic waste.

A lack of interest and compliance is one of the critical concerns of communication fatigue in public health communication. When people are continually bombarded with a lot of information and messaging, they may get desensitised and tune it out. This might lead to a lack of incentive to adopt healthy behaviours or follow public health norms, perhaps increasing disease spread.

Corrective action and celebration triage is needed urgently!

Disease burden and national strategic plans should guide the choice of three to five health days to mark in a year. An uninterrupted barrage of visuals of inaugurations, closing ceremonies and speechmakers on social media is not the best health communication investment and risks reducing the credibility of those seen engaging in this. Effective communication strategies, such as using a variety of communication channels and formats, can help prevent communication fatigue and promote healthy behaviours. Choosing to tone down communication and spacing is also a wise strategy.

Between the devil and the deep sea- tough choices for the poor

This is easier said than done, especially in countries that rely heavily on foreign aid to fund critical services like healthcare. Public employees in these countries are often needed to attend meetings and such events with international donors to seek financing, manage projects, and report on progress. While working with international donors is vital to get funding and promote development programs, there are significant risks involved with public officials becoming overly focused and exposed to ceremonial roles and not being seen in critical policymaking.

Post-COVID-19, the way countries have rolled back special measures like mandatory mask usage, pre-departure forms, and media briefings, it is time to tone down public health communication. The audience needs a breather. There is an urgent need to shift to strategic health communication to achieve focused public health objectives. This approach requires a deep understanding of the local context, the target audience, and the social, cultural, and economic factors that impact health behaviours. Unfortunately, most international health actors are in shortage of talent with the capacity to do this. Worse is the fear that they may not see this need until the next health emergency knocks at our doors.

Time to cut down the noise and deliver solid results!

The globe is falling short of meeting the targets for the health-related Sustainable Development Goals 2030. However, if governments are to meet these targets, they must prioritize policies and execution while reducing general health communication surrounding health days, events, and celebrations. It’s time to turn down the volume and avoid health communication burnout!

Published in The Himalayan Times, Thursday, 16th March 2023. Page 4.

About the Author

Dr Sunoor Verma is a global health practitioner. He has advised WHO, UNICEF, UNHCR, HUG-Geneva and Cambridge University on Strategy, Leadership Communication, Advocacy and Resource Mobilization. He is credited with setting up WHO’s communication portfolio from scratch in Nepal in the midst of COVID-19. He has set up and led the country and regional operations for the European Centre for Minority Issues in the Balkans. He has supported track two peace processes in Macedonia, Kosovo and Sri Lanka and emergency response to the Tsunami, Avian Influenza and COVID-19. He has taught Global Health at Boston University. He has curated partnership initiatives with Macedonia, Kosovo, Germany, Switzerland, Australia, and Nepal parliamentarians. He divides his time between the foothills of the Jura Mountains in France and Buddhanilkantha in Nepal.

Public Health debates we can ignore at our own peril

Posted on June 30, 2022 by sunoor

public health

Global lessons learnt are not as valuable as we might think!

Having lived and worked in low-, middle- and high-income countries, I do not like sweeping ‘global lessons learnt’. The situational, cultural, and operational contexts based on countries’ income levels vary hugely. Moreover, the reports and recommendations from global apex bodies are often drafted by people from primarily high-income country experiences. Many of them may have never actually worked at the country level. Often their lexica are so watered down in assessments of low-income countries that severe reprimand ends up sounding like applause by publication. Without a scorecard system where each country would know where they need to improve to achieve standards, it is difficult to get a reality check. We, the low-income countries, have a choice to make. We can believe that we are high performers or quench our vanity, critically examine our performance, and take corrective measures.

The glaring gaps in public health that COVID-19 exposed

COVID-19 has exposed critical societal gaps across the globe. In the case of high-income-developed democracies, this means adjustments and fine-tuning. In the case of low-income countries, this has meant seeing a horrid picture in the mirror and the need for transformational change. So a natural enquiry would be-what has been happening in the business of Health Systems Strengthening over the years and billions of donated dollars later? We would have thought that SARS, Ebola, MERS, and ZIKA emergencies would have better prepared our health systems, but here we are.

This pandemic has opened some chronic societal wounds, especially in low-income countries. The top issue that warrants an urgent societal debate is what services are essential and must remain in the public domain and how we regulate the private sector. Many proponents for the rapid privatisation of public services in low-income countries are foreign experts. Their countries have achieved an equilibrium between top-notch public services and effective private-sector regulation.

Public Health, Corruption & Transparency

Corruption, lack of transparency, power asymmetry, and invisibility of women in decision-making all contribute to the complexity of public versus private debate in low-income countries. When lawmakers overtly or by proxy own significant numbers of private hospitals, mainstream media, and educational institutions, it becomes difficult to have an objective national debate. The COVID-19 pandemic has allowed us to rethink and reboot societal contracts. The pandemic struck when public trust in institutions- governmental, civil society, private sector, media, academia, and the judiciary was at the lowest after years of steady decline globally.

Public sector- the saviour during COVID-19

Suppose we reflect on the past two years of the pandemic in low-income countries. In that case, we will note that we turned to either the public sector organisation or the defence forces whenever we needed a timely nationwide response. For example, when students needed to be brought back from abroad in India, the then-national carrier Air India stepped up. When stranded migrant workers needed to return home, it was the Indian Railways that rose to the occasion. When liquid oxygen had to be mobilised, the public sector was at work again. Working around the clock to secure scarce supplies from other countries and securing evacuation permissions were diplomats who are public servants. On the borders, facilitating the movement of people, supporting testing, quarantine etc., were members of the border police, armed forces, and the police. Similar was the case with many countries in South and Southeast Asia.

Other rich countries, such as Germany and South Korea, responded robustly. Attribution to the ability of their governments to manage private-sector activity and essentially public ownership of critical health system elements. Their impressive testing capacity was thanks to public laboratories and the presence of industries that could supply the required safety equipment and chemicals.

The South and Southeast Asia neighbourhood

Some governments in Southeast Asia have managed to build public health systems that learn. So, lessons from SARS and Tsunami have fed into their preparedness systems, allowing them to respond efficiently and effectively. The city-state of Singapore has traditionally shown a proactive approach based on solid scenario planning and proactive public health communication. Within India, the response of the southern state of Kerala has stood out. Over the decades, Kerala has invested in health, education, and women’s empowerment. It has consistently adopted an evidence-based approach to decision-making on health matters. Theirs is a learning system that drew heavily on lessons from the NIPAH virus emergency not too long ago. Kerala has also avoided the black-and-white notion of Public or Private and established a successful public-private partnership model. The government of Vietnam efficiently diagnosed the regional situation and closed its borders. Similarly, they were swift in developing low-cost test kits.

Public Health and the private vs public discourse- an axis of national security too

The considerations that need to be at the centre of this post-COVID-19 public-private discourse are:

Re-evaluate and reign in the privatisation spree of health-related assets and services. Nurture back to health underperforming units through quick and transparent reform.
Two, Reboot and relaunch sensible and practical national health policies that serve the objective of achieving universal health coverage. These should not be a copy-paste of what middle- or high-income countries are doing but should be rooted in the realities of poverty, patriarchy, and emerging democracy.
Three, While the issue may appear to be of health, the scope of solution searching is well beyond the expertise or experience of health actors. The complexity of this matter warrants the leadership of the Ministries of Finance, Law, Commerce and Home. For example, supply chains, the rule of law during the lockdown, transportation of people, and labour issues related to health workers have solutions outside of health agencies’ remit.
Four, Governments must take the lead and regulate the private sector more effectively and transparently. While governing the somewhat more streamlined public sector may be more satisfying, the rapidly and wildly growing private sector needs aggressive regulation. In many low-income countries, this means enforcing the existing fantastic on-paper rules and not drafting new ones. Moreover, the hopelessness of data collection from private sector health providers, whether on testing, bed occupancy, oxygen availability, or mortality during COVID-19, has hampered many low-income countries’ effective and timely response.

Refocusing on the Health for All agenda

This public discourse requires us to open our eyes to what we witnessed in the last two years and set aside our ambition and vanity. Let us acknowledge the actual situation in our countries and not artificially push ourselves into a higher boxing category for mere prestige. Organic, home-grown solutions are needed now, not a collage of random international best practices. Instead of drawing lessons from countries in the region, we need to study states and provinces with similar challenges and partner with them. Cross-border areas should be of interest in standard solution searching.

Many glorious careers are built worldwide in the name of Health Systems Strengthening. However, COVID-19 has shown that not much strengthening may have happened. WHO’s “Health for All” agenda ought to remain our focus. However, the tools, processes and commitment need to be indigenous. Countries must bring their sharpest, most independent, and most fearless minds to this debate.

Let us not forget that health, education, and security are nation-building tools. Taxpayers will have little incentive to contribute their fair share if all these continue being disproportionately privatised. One can only imagine the threat to democracy this will pose.

About the Author

Dr Sunoor Verma is a global health practitioner. He has advised WHO, UNICEF, UNHCR, HUG-Geneva and Cambridge University on Strategy, Leadership Communication, Advocacy and Resource Mobilization. He is credited with setting up WHO’s communication portfolio from scratch in Nepal in the midst of COVID-19. He has set up and led the country and regional operations for the European Centre for Minority Issues in the Balkans. He has supported track two peace processes in Macedonia, Kosovo and Sri Lanka and emergency response to the Tsunami, Avian Influenza and COVID-19. He has taught Global Health at Boston University. He has curated partnership initiatives with Macedonia, Kosovo, Germany, Switzerland, Australia, and Nepal parliamentarians. He divides his time between the foothills of the Jura Mountains in France and Buddhanilkantha in Nepal.

Published in Nepal’s national daily Kantipur on 30 June 2022 in Nepali language. This is a translation with some additional text.

An urgent and critical re-think of global health governance and mandates is warranted!

Posted on April 22, 2022 by sunoor

Dr Sunoor Verma’s interview Face to Face with The Himalayan Times. Published on 22^nd April 2022

The Himalayan Times (THT) Question: In an interview with THT in March 2020, your predictions on how COVID-19 will play out came true. So, what has changed in the global health business in these two years?

Dr Sunoor: It seems to me that COVID-19 has shown countries, policymakers, technocrats, businesspersons, and the media the mirror. And the picture in the mirror was far from pretty. Years of under-investment in health as public service and health professionals have brought us to despair. We also saw that when there is strong cooperation between high-income countries and multilateral agencies like WHO, there can be accelerated solution-finding, as with vaccine development. At the same time, we saw that not much has changed on the axis- rich and poor. The rich controlled the allocation of essential Covid19 supplies. The helplessness of the poor, both as individuals and as countries and their dependency on acts of charity by rich countries is one strong memory of the last two years. I believe that what has also changed over the previous two years is the frivolous questioning of WHO‘s relevance. The UN’s health agency has long been the favourite punching bag of health stakeholders. With all the shortcomings of any membership organisation, WHO has shown that it is more than a normative and standards body. Its power of convening health actors has been hugely visible and effective these past two COVID-19 years. Low-income countries often vent on UN agencies for their miseries, especially the WHO. This is because they cannot box donor countries as they welcome the bilateral money that flows from them. Many member states ask WHO to be stronger, wiser, braver, etc. They must realise that WHO is the sum of the strength of its member states. Low-income countries can only contribute to WHO’s strengthening by making their health systems solid and practical for the commoner. All said and done; global health governance needs a rethink and recalibration. India, Brazil, Thailand and many others who until now were regarded at the periphery of global health governance architecture have unequivocally demonstrated their strength.

THT: What are the lessons for low-income countries from the last two years of COVID-19?

Dr Sunoor: Negotiation from a position of poverty is a non-starter. Least so during a global health crisis. While globalisation has been much celebrated, the poor have not benefitted proportionately. I hope that developing countries learn that health must transcend nationalism and regional alliances must be made as disease crosses borders quickly. Instead of each country reinventing institutions, regional health resources must be shared. They should be recognised and shared regionally by setting up laboratories, training facilities, stockpiling drug testing, and registration. It is a pity that regional fora such as SAARC have not developed to their potential and around the topic of health remain rudderless. Once again, with the facilitation of bodies like WHO, there was support for utilising the capacities of member states during COVID-19. However, these should be a reflex of countries and not the cajoling of international bodies. Regional global health alliances need to be forged now. These need to be regional in operations and financing yet learning from global systems.

Another vital lesson is the importance of activating existing emergency and disaster mechanisms over inventing new structures on the go. Some countries learned that emergencies are not the best time for adventure but rather for tested mechanisms.

THT: As you work closely with leaders and elected officials on strategy and leadership communication around the globe, what lessons are there from COVID-19 for leaders?

Dr Sunoor: COVID-19 has shown the importance of leaders exercising leadership. Occupying a leadership position is no guarantee of leadership. There is ample evidence and peer-reviewed research that countries where women have been in leadership positions on COVID-19, have fared better in their response. Power asymmetry against women in our countries in South Asia is a barrier to our emergency response, development, and prosperity. Excluding women from top-tier decision-making has been a blunder that should be corrected for future emergencies. An important message for leaders is that excluding women from decision-making is foolish and expensive. Donors should make grants available only subject to at least a fifty per cent representation of women in the steering committees of any project they fund in recipient countries.

Second, leaders have seen that undisciplined, unplanned, and unverified communication during health crises leads to the death of people. Third, communicating science and scientific messages to a broad and diverse audience is challenging and beyond the scope of many politicians and leaders. Either they should follow advice and scripts prepared by experts or appoint their own “Faucis” and let them do their job without interference. The top communicators on COVID-19 among leaders have been the former Chancellor of Germany and the Prime Minister of New Zealand. While Mrs Angela Merkel, a scientist, simplified complex data for her citizens in direct telecasts, Ms Jacinda Ardern showed unprecedented transparency in decision-making. If you don’t understand science, don’t deny it or twist it but appoint experts to communicate it and let them do their job.

Another lesson for leaders, I hope, is that they must be unifiers and not dividers in crisis. When people suffer, the last thing they want to see is their leaders’ bickering. The ability to transcend petty politics and create an environment of a unified national response is critical. Unfortunately, few leaders around the world have achieved this feat during COVID-19.

THT: In the post, COVID-19 world order, are multilateral agencies like WHO still relevant? Does their role need to evolve?

Dr Sunoor: Close your eyes for thirty seconds and visualize COVID-19 without WHO.

The question of relevance arises only if there is an alternative. In a world divided along the axis of income, gender, faith, ethnicity etc., the importance of a convener and facilitator is critical. WHO has outstandingly supported countries in their COVID-19 response, especially for an underfunded organisation. Do such agencies need to evolve or transform? Yes, of course, we all need to evolve constantly. High-income countries that fund much of the budget of WHO should want a transformed organisation and support that journey consistently and systematically. Low-income countries should better appreciate the rich-poor power asymmetry more realistically and temper their expectations accordingly.

I also feel that a new kind of expertise is needed in the global health arena. While countries need the norms and standards-setting from an apex body; however, their country-level implementation requires more than technical expertise. It requires coalition-building and diplomacy talent to help countries navigate their factions and mazes. Twenty years ago, people expected disease elimination from WHO; today, they expect WHO also to deliver health and well-being. This warrants an ability to look beyond WHO’s traditional matrimony to government health agencies and forge partnerships with national finance, policy planning, youth, education, and technology custodians. Finally, for any international agency, it is crucial to set clear criteria on when to exit a country, announce it, and adhere to that handover. How many flags you can pin on the world map should not matter in a Zoom world.

THT: Lastly, what conversations are essential now, drawing from the COVID-19 experiences as a society or global community?

Dr Sunoor: A core question that societies need to debate is what should remain in the public sphere and what in private? We have seen that countries with a robust public system of services have done much better in their emergency COVID-19 response. This is an important question, especially for low- and middle-income countries with an urgency to privatise public institutions and services in a call for greater efficiency. Some countries that advocate privatisation in aid-recipient countries have maintained solid public service systems in their own countries. So, this needs to be an organic debate in situ.

At the citizen level, I hope we will appreciate that Health is Politics. Voters would need to demand of their politicians the fundamental right to good quality health, education, and nutrition. And hopefully, this is what the ballot would be cast on in future.

About the Author

The WHO is not our nanny!

Posted on April 2, 2020 by sunoor

Published in The Himalayan Times on 2nd April 2020

WHO, World Health Organisation

Is WHO our global health nanny?

Expecting the World Health Organisation (WHO) to be our universal nanny is unrealistic and dangerous, especially in times of crisis. WHO is a body that brings together global expertise, health intelligence and experience to all its member states. Every organisation essentially represents the nature of its membership and what its members want it to be. WHO is made by your governments. Countries must take WHO’s guidance as their core ‘plan minimum’ and add to it their wisdom.

Imagine the COVID-19 response without the WHO

Gripped by COVID-19, all eyes are on WHO for guidance on what to do and what not to do? All it takes is to imagine our response to the pandemic without the WHO. All said and done common perception is that this is an organisation owned by member states and would be the closest that we could get to neutral information. Many criticise WHO for being influenced by one powerful state or another. However, no one has developed an alternative body that would enjoy the reach or brand recognition of WHO while maintaining the entire range of health expertise from epidemics to road injuries. Governments quote the WHO, and follow its guidance and feedback data into it. The network of collaborative centres that the WHO operates in partnerships with academia and government is an immense asset to the global pool of knowledge and capacity.

What started as a health crisis has very rapidly evolved into a societal crisis. Some countries have declared COVID-19 a national security crisis, some have termed it a national disaster, and others have termed it a war. It is essential in this context to understand the role of the WHO, lower our expectations of it and shift specific tasks and responsibilities to other actors.

Shift expectations away from WHO to other agencies

While the WHO teams around the globe churn out a range of information material on how to deal with COVID19, other actors need to take that information forward to their constituents. Take, for example, the WHO‘s social distancing guidelines. These ought to be taken up by organisations within countries, modified to the local context, translated into the local languages and amplified using channels that work best in that given context. Marinating in inaction, awaiting tailor-made guidance for every population segment for every country is a luxury we can not afford now. In the country context, line ministries need to step up their game and use their intelligence to customise the science coming out of the WHO and channel it to their captive audiences. Spoon-feeding is not an option in times of crisis. Similar to the WHO, as Ministries of Health are overwhelmed in responding to the COVID19, line ministries should not self-paralyse for lack of vetting of each communication piece from their Ministry of Health counterparts. There is neither time nor any human resources that can be spared for this. In multiplying and amplifying messages, mistakes might be made here and there, but they can be corrected. The risk of doing nothing is way higher than making a few mistakes.

Help WHO deliver on its core mandate

Every emergency coordination meeting I have attended at a country, regional or headquarters level invariably ends with one default recommendation- we must coordinate better. Pick any emergency response evaluation, and you will see the same outcome. While coordination during a crisis may hold some limited promise within sectors- e.g. UN country teams, International NGOs, and government ministries, it rarely works between industries. It is no different from how things function or don’t within a building of tenants or extended family- some will always go solo or only halfheartedly implement agreements. I have found this to be valid as emergencies draw out. In a COVID-19 global crisis, let us allow WHO to focus on giving the world its best technical intelligence and advice. Let us not put it under the expectation of global babysitting. It is the time to encourage all other ministries, organisations, industrial bodies, and associations to study, digest and use the WHO‘s knowledge and advance it to their audiences as quickly as possible using their innate intelligence and experience.

Let us help the WHO focus on its core knowledge generation and dissemination business. It is time for each of us to step up to our duty of using WHO‘s output responsibly and proactively in beating the menace of COVID19.

About the Author

Dr Sunoor Verma is a former Cardiothoracic surgeon; his experience ranges from various emergency settings related to the Avian Flu, SARS, Tsunami, HIV/AIDS, Kosovo crisis, Macedonia armed conflict and the Sri Lanka conflict. His focus is Strategy, Risk and Crisis Communication and Strategic Partnerships in international development. He has advised WHO, UNICEF UNHCR, the European Centre for Minority Issues, Cambridge University, Boston University and the Hospitals of the University of Geneva. He balances his high-level policy work with advisory work to grassroots NGOs worldwide. He works out of the Lake Geneva region.

Collective action needed to exit from COVID-19 crisis

Posted on March 24, 2020 by sunoor

COVID-19, Sunoor Verma, Nepal,

What should the roles of government, private sector and the general public be in terms of crisis communication?

Crisis communication is very different from regular communication. This is because the way people perceive threat, process information and react to information is very different from that of the regular scenario.

The other challenge we face in the globally connected media is that we are watching what is happening in developed countries. Suddenly our own expectations from our own governments become unrealistically high. But we have to realise our own context and manage our expectations in that context.

Governments need to see that people expect information quickly to make themselves and their close ones safe. Second, they want reliable information. Third, they want information they can turn into action for themselves so that they can take their safety into their own hands.

The people need reliable information from governments, and governments need collaboration and cooperation from the people. These two elements need to be in harmony. For that to happen, there needs to be a single source of information that is trusted. In the case of this epidemic, the official government mechanism and the World Health Organisation are the only two sources from where we take the information.

Then there’s the role of leaders in other sectors. Leaders do not only mean elected leaders. We are looking at leadership from all sectors — within the private sector, the faith sector, and within the community sector.

For example, if I am a shopkeeper in Kathmandu, I should not expect the government or WHO to come up with a protocol on how to maintain social distancing at the shop. Shopkeepers, or their associations, should decide how we manage social distancing at shops.

Also, videos on how to wash hands from developed countries show people washing their hands for 30 seconds under running water. Where do we get running water in Nepal? Our reality is a mug of water. We need a video on how to wash our hands with a mug of water for 30 seconds. This is not something we expect the government or the WHO to come up with. There are so many creators, YouTube stars and influencers. They can make their 30-second video.

It should be clear there’s no individual exit from this. The only way we can exit from this is through collective action. So this is the first time, I think, we are facing a crisis where it does not matter whether you are rich or poor; literate or illiterate; male or female; Hindu or Muslim or Buddhist.

Your survival depends on your neighbour. This is a massive equaliser. So crisis communication needs to be mastered very quickly by leaders in all spheres of life.

How can the private sector, which has yet to come out in Nepal, address this crisis?

It is very important for the private sector to step up to see what the government is doing and immediately come up with offers of action and support. This is not the time to negotiate product placement, visibility, brand logo, etc. This is the time for the private sector to unite most effectively through their associations. That way, the interests are not competing within companies or brands. It’s an industry coming together.

For example, an industry of manufacturers comes together. See what the government is doing. See what the messaging is and think about how they can take the message forward into areas they influence. How they can multiply and amplify the message and make it more understandable for their constituents. They must also start thinking of scenarios in future planning. At the moment, we are all thinking about the crisis. We are not thinking after the crisis.

When the private sector starts helping out, the government will also probably ask the private sector for things they could do. For example, Airbus and Rolls Royce are presently not manufacturing aeroplanes or engines, but they are manufacturing ventilators.

Everywhere in the world, countries are following one model of lockdown to slow down the spread of novel coronavirus. How sustainable is that model, especially for a country like Nepal where people have to go out to work every day to eke out a living?

This is where multilateralism comes in. Countries, no matter how independent and how proud, this crisis reminds us we are not independent but we are interdependent. So when we are interdependent, we have to use each other’s strengths to understand who is working how and resolving the problems through which means, and pick from there.

This is where multilateralism, regionalism, regional cooperation all come in. You can see China has sent a medical team to Italy. Cuba has just sent 50 doctors to Italy as well. So we need to see our partners who can help us in what manner. And help is not just with financial aid but with ideas. We also have to realise that solutions will emerge as we move on.

The other thing that we should ask ourselves is what the other option to the model of lockdown there is. Let’s start with the one option we’ve seen working everywhere until we have another option. In the meantime, we develop solutions as they emerge or as the problem evolves. But I do not think we have the luxury of waiting.

Is this crisis forcing everybody, even those writing off multilateralism, to rethink it?

Multilateralism is criticised because it is a soft and favourite punching bag for everyone. Any organisation, in essence, reflects the members it has. The United Nations is what its members are and what its members want it to be. But it is an easy punching bag because it is not easy for a country to go and punch an individual member which is more affluent, bigger and more powerful. But the COVID-19 crisis is reminding us about the importance of the WHO with its vast networks of collaborators of laboratories around the world, sharing information, pooling data and working 24 hours a day. If this system of multilateralism was not there, you would not have the WHO. Then the question would be, whose information would you trust? Of course, the UN system has to reflect modern society. But it is very big, and it takes time to change. Member states have to also think about it.

You have the luxury of so many UN agencies in Nepal. These agencies have programmes around the countries. So here you have channels and expertise spread around the country from a multilateral organisation where you are a member, where you can demand help. The UN offices are open, and all the heads of the UN agencies are in their offices.

How do you think this crisis is going to end as people paint a gloomy picture?

This whole experience poses questions on how we function as a society and in governance. So people and governments have a choice — will they make decisions based on scientific evidence? The second choice is whether we are going to support the public health sector or not. You can see the delay in response to COVID-19 in the US is attributed by many to reduced funding of the public health sector in the last few years.

In terms of the gloomy picture, science tells us virus evolves. The whole idea of the lockdown is to delay how the virus moves from one person to another. Hopefully, several parameters will change until we manage to postpone this, such as heat and humidity and hopefully, infections go down. So I think the evolution would gradually become that of the flu. It might re-emerge in November or December when seasonal flu occurs, but most scientists feel the virus would have evolved or mutated by then. But I think we do not have the luxury of long-term scenario planning in a crisis like this. We need to start step by step based on the experience that is evident around us. China has managed to bring it under control, South Korea is doing quite well, and Taiwan and Singapore have done quite well.

If you look at countries that have done well, they have been very strong in crisis communication and supply chain management. I think many of these countries have outstanding relations with Nepal. I think the way forward is to seek their expertise and support. Nepal is a full-fledged member of the United Nations. There’s immense recognition of Nepal’s contribution to the peacekeeping forces. Nepal has helped the world. Now Nepal needs help; I think the world will stand to support Nepal.

About the Author

Sunoor Verma is a senior international development specialist in strategic planning, strategic and risk communications and strategic partnerships. His experience includes advisory work for the World Health Organisation, UNHCR, UNICEF, European Centre for Minority Issues, Cambridge University, University of Geneva and Boston University. Most recently, he consulted WHO-Geneva on developing their Risk Communication Strategy for Pandemic influenza.

Roshan S Nepal of The Himalayan Times caught up with Dr Sunoor to talk about the importance of crisis communication in this time of COVID-19 pandemic. Published on 24th March 2020 in The Himalayan Times English national daily newspaper Nepal.

Antevasins from the worlds of technology and health- please unite!

Posted on October 12, 2013 by sunoor

Technology and Health

Mention ‘technology and health’ and discussions generally steer into the direction of various gadgets and devices that transmit data, help remote diagnostics or empower patients to better manage their chronic conditions. The use of Google glasses by surgeons worldwide is the latest in generating such excitement. This is understandable in an era of short attention spans, where we tend to choose the visibly most exciting and the one that can be touched, tried and tested. While these new inventions are thrilling, most remain in the realm of luxury for a large part of the world. What often remains invisible and under-acknowledged is information and communication technology’s (ICT) ‘s role in transforming the landscape of broader issues such as power and access. At first instance, this may seem unrelated to health. However, these disruptions that ICT can make carry the potential to make health more accessible.

The truth behind “Access to Health”

‘Access to health’ questions are essentially questions of power imbalances, equity and human rights. Information and communication technology are essential for de-monopolising information and power and bypassing corruption. Communities where girls and women are not allowed to step out of their homes to go to schools, can now be reached in their homes through eLearning programs. Digitization of land records in feudal societies leads to major power shifts in communities. These shifts create new opportunities for people to think beyond ‘survival’. When such developments are coupled with legislation that empowers citizens with the right to information, wonders can happen in many fields, including health. The potential of transparency and rapid dissemination of information that ICT brings warrants close collaboration between champions of access to health and technologists. This should not be considered relevant only in the low-income- resource-constrained setting but also in the high-income countries where health cost is skyrocketing.

Integrating technology thinking into health thinking

If we wish to make health accessible for more people in more places in the world, we would need to find effective ways of integrating ‘technology thinking’ into ‘health thinking’. In the current scenario, technology is seen in service to health – a vehicle for carrying forward health services and products. The vehicle and the product are usually developed independently, and their coming together is more often coincidentally than by design. In health projects, I often see technology as an afterthought, not an integral element of the project design.

While ‘inter-disciplinarity’ is a term tossed around by global health gurus and policy writers, it is a mammoth task to achieve in practice. The first step towards this integrated thinking would be to create dialogue spaces that are conducive for the meetings of the Antevasins from the worlds of technology and health.

Antevasins- the need of the hour

Antevasin (Ante-vasin n. Sanskrit) loosely translates as ‘living at the borders’. This word gained quite some popularity when used in the book “Eat, Pray, Love” by Elizabeth Gilbert. Finding Antevasins in the area of Health and Technology is a challenge as both fields take pride in their super-specialists. Add to this the tendency of people to put experts in health and technology in a box. However, it is vital that we search for those who, while having their niche of expertise, can see the bigger picture and appreciate the importance of connecting with ‘outsiders’.

Med@Tel- a pioneer!

I had the privilege of attending the annual conference of the ISfTeH in Luxembourg 2013- Med@Tel. The size of the conference, the sessions, the layout and the staff that managed the event created an ambience conducive to networking beyond the customary exchange of visiting cards. To my delight, at Med@Tel, I met an impressive number of Technology Antevasins. Saddened I was to see few from my own tribe of health and medicine at the conference. This led to our proposal of a thematic partnership between the ISfTeH and the Geneva Health Forum.

Since 2006 the Geneva Health Forum (GHF) has asked hard questions, invited practical solutions, and heard many brave voices worldwide. As the world gets more complicated and health more vital, we have partnered with ISfTeH to strengthen the ICT component of the GHF 2014. We have operationalized this by dedicating a complete submission track to Innovation and technology at the next edition of the GHF in 2014.

Content is King

Over the last four editions of the forum, we have tried to ensure that partners appreciate the value proposition of the Geneva Health Forum and commit to contributing to its content. The fruits of these efforts were clearly visible in the fourth edition in 2012. This has also enhanced the credibility of the GHF as a forum where ‘Content is King’. Gradually partners have come to value the unique dialogue and networking opportunities the GHF provides. Many partners have also found value in getting access to the views from the frontlines that the GHF channels, which may show trends that may initially be invisible to policymakers in Geneva.

We are confident in the robustness of the product that we are bringing forward. We feel the content will prevail over packaging in a fast-moving world of multiple and non-stop choices. The global health community has no more patience for predictable, self-asserting and mind-numbing meetings, conferences and sessions. It is time to raise the bar and bring back discussions and debates that make health more powerful.

Not for fence-sitters

The Geneva Health Forum is not meant to attract spinners and fence-sitters. It is a forum of Antevasins from across disciplines that can see beyond their own spheres of expertise, excellence and influence. It is a forum that brings together believers of interdependence over independence. I earnestly hope that members of the ISfTeH will participate and infuse the discussions at GHF2014. We know that without ICT, health initiatives cannot scale. At the same time, we will encourage health experts to engage at your fora and bring their perspectives to challenges and possible solutions to advance health and well-being. I invite you to visit the website of the GHF.

I earnestly hope the partnership between ISfTeH and the GHF will lead to new disruptions that will make health more powerful.

I wish you good health!

Sincerely yours,

Dr. Sunoor Verma, MD MS

Executive Director

Geneva Health Forum

Editorial by

Dr. Sunoor Verma, Executive Director of the Geneva Health Forum published in the October 2013 Newsletter of the ISfTeH

Dear Reader,

As I indicated last year, from time to time, I will allow a member of our community to use this space to share their thoughts with everyone. Dr Sunoor Verma, Executive Director of the Geneva Health Forum, is the first to take advantage of this, with his piece on the people who straddle the worlds of health and technology as we do. The ISfTeH signed a memorandum of understanding with the Geneva Health Forum this summer. We all look forward to a mutually beneficial collaboration with the GHF.

Sincerely,

Prof. S. Yunkap Kwankam

Executive Director, ISfTeH